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Cited by 224Colorectal Cancer Screening and DetectionAI in cancer detectionColorectal Cancer Surgical Treatments

Real-Time Optical Biopsy of Colon Polyps With Narrow Band Imaging in Community Practice Does Not Yet Meet Key Thresholds for Clinical Decisions

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Ladabaum, Uri, Fioritto, Ann, Mitani, Aya, Desai, Manisha, Kim, Jane P., Rex, Douglas K., Imperiale, Thomas, Gunaratnam, Naresh·2013·Gastroenterology
DOI 10.1053/j.gastro.2012.09.054PMC PMC5518757
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Abstract

Background & aims Accurate optical analysis of colorectal polyps (optical biopsy) could prevent unnecessary polypectomies or allow a "resect and discard" strategy with surveillance intervals determined based on the results of the optical biopsy; this could be less expensive than histopathologic analysis of polyps. We prospectively evaluated real-time optical biopsy analysis of polyps with narrow band imaging (NBI) by community-based gastroenterologists. Methods We first analyzed a computerized module to train gastroenterologists (N = 13) in optical biopsy skills using photographs of polyps. Then we evaluated a practice-based learning program for these gastroenterologists (n = 12) that included real-time optical analysis of polyps in vivo, comparison of optical biopsy predictions to histopathologic analysis, and ongoing feedback on performance. Results Twelve of 13 subjects identified adenomas with >90% accuracy at the end of the computer study, and 3 of 12 subjects did so with accuracy ≥90% in the in vivo study. Learning curves showed considerable variation among batches of polyps. For diminutive rectosigmoid polyps assessed with high confidence at the end of the study, adenomas were identified with mean (95% confidence interval [CI]) accuracy, sensitivity, specificity, and negative predictive values of 81% (73%-89%), 85% (74%-96%), 78% (66%-92%), and 91% (86%-97%), respectively. The adjusted odds ratio for high confidence as a predictor of accuracy was 1.8 (95% CI, 1.3-2.5). The agreement between surveillance recommendations informed by high-confidence NBI analysis of diminutive polyps and results from histopathologic analysis of all polyps was 80% (95% CI, 77%-82%). Conclusions In an evaluation of real-time optical biopsy analysis of polyps with NBI, only 25% of gastroenterologists assessed polyps with ≥90% accuracy. The negative predictive value for identification of adenomas, but not the surveillance interval agreement, met the American Society for Gastrointestinal Endoscopy-recommended thresholds for optical biopsy. Better results in community practice must be achieved before NBI-based optical biopsy methods can be used routinely to evaluate polyps; ClinicalTrials.gov number, NCT01638091.

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  • Colorectal polyps were histologically characterized as adenoma, hyperplastic polyp, or sessile serrated lesion by expert pathologists according to the revised Vienna and World Health Organization classification.

    “Colorectal polyps were histologically characterized as adenoma (AD), HP, or sessile serrated lesion (SSL) by expert pathologists according to the revised Vienna and World Health Organization classification.3,4”

    From Structured Integration of an Artificial Intelligence-Based System for the Optical Diagnosis of Colorectal Polyps (2026) · cites this paper as [4]

    The Methods (In Vivo Phase of the Study; Statistical Analysis, page unavailable) say that pathology reports supplied polyp diagnoses and distinguish adenomas from sessile serrated adenomas; the paper also discusses hyperplastic polyps. Our copy does not say that expert pathologists made the diagnoses or that they used the revised Vienna and WHO classifications. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • The limited clinical uptake of diagnose-and-leave and resect-and-discard strategies is due to their suboptimal accuracy.

    “However, the limited clinical uptake of these strategies is due to their suboptimal accuracy.3-6”

    From Structured Integration of an Artificial Intelligence-Based System for the Optical Diagnosis of Colorectal Polyps (2026) · cites this paper as [4]

    The Discussion (page unavailable) says high performance is important for acceptance of resect-and-discard and that leaving polyps in place requires a very high negative predictive value. The paper also reports that surveillance-interval agreement fell below the recommended threshold in its community-practice NBI study. It does not measure clinical uptake or establish that suboptimal accuracy is the cause of limited uptake of both strategies generally. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

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Research works printed but not linked: 29

  1. [1]Rex DK Kahi C O’Brien M The American Society for Gastrointestinal Endoscopy PIVI (Preservation and Incorporation of Valuable Endoscopic Innovations) on real-time endoscopic assessment of the histology of diminutive colorectal polyps Gastrointest Endosc 2011 73 419 422 21353837
  2. [2]Oba S Tanaka S Sano Y Current status of narrow-band imaging magnifying colonoscopy for colorectal neoplasia in Japan Digestion 2011 83 167 172 21266811
  3. [3]Rastogi A Keighley J Singh V High accuracy of narrow band imaging without magnification for the real-time characterization of polyp histology and its comparison with high-definition white light colonoscopy: a prospective study Am J Gastroenterol 2009 104 2422 2430 19584829
  4. [4]Rex DK Narrow-band imaging without optical magnification for histologic analysis of colorectal polyps Gastroenterology 2009 136 1174 1181 19187781
  5. [5]Sano Y Ikematsu H Fu KI Meshed capillary vessels by use of narrow-band imaging for differential diagnosis of small colorectal polyps Gastrointest Endosc 2009 69 278 283 18951131
  6. [6]Higashi R Uraoka T Kato J Diagnostic accuracy of narrow-band imaging and pit pattern analysis significantly improved for less-experienced endoscopists after an expanded training program Gastrointest Endosc 2010 72 127 135 20493482
  7. [7]Ignjatovic A Thomas-Gibson S East JE Development and validation of a training module on the use of narrow-band imaging in differentiation of small adenomas from hyperplastic colorectal polyps Gastrointest Endosc 2011 73 128 133 21184878
  8. [8]Raghavendra M Hewett DG Rex DK Differentiating adenomas from hyperplastic colorectal polyps: narrow-band imaging can be learned in 20 minutes Gastrointest Endosc 2010 72 572 576 20561618
  9. [9]van den Broek FJ van Soest EJ Naber AH Combining autofluorescence imaging and narrow-band imaging for the differentiation of adenomas from non-neoplastic colonic polyps among experienced and non-experienced endoscopists Am J Gastroenterol 2009 104 1498 1507 19491863
  10. [10]Boparai KS van den Broek FJ van Eeden S Hyperplastic polyposis syndrome: a pilot study for the differentiation of polyps by using high-resolution endoscopy, autofluorescence imaging, and narrow-band imaging Gastrointest Endosc 2009 70 947 955 19595313
  11. [11]Ignjatovic A East JE Suzuki N Optical diagnosis of small colorectal polyps at routine colonoscopy (Detect InSpect ChAracterise Resect and Discard; DISCARD trial): a prospective cohort study Lancet Oncol 2009 10 1171 1178 19910250
  12. [12]Levin B Lieberman DA McFarland B Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology Gastroenterology 2008 134 1570 1595 18384785
  13. [13]Gupta N Bansal A Rao D Accuracy of in vivo optical diagnosis of colon polyp histology by narrow-band imaging in predicting colonoscopy surveillance intervals Gastrointest Endosc 2012 75 494 502 22032847
  14. [14]Lieberman DA Rex DK Winawer SJ Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer Gastroenterology 2012 143 844 857 22763141
  15. [15]Rogart JN Jain D Siddiqui UD Narrow-band imaging without high magnification to differentiate polyps during real-time colonoscopy: improvement with experience Gastrointest Endosc 2008 68 1136 1145 18691708
  16. [16]Rastogi A Early DS Gupta N Randomized, controlled trial of standard-definition white-light, high-definition white-light, and narrow-band imaging colonoscopy for the detection of colon polyps and prediction of polyp histology Gastrointest Endosc 2011 74 593 602 21802078
  17. [17]Rastogi A Pondugula K Bansal A Recognition of surface mucosal and vascular patterns of colon polyps by using narrow-band imaging: interobserver and intraobserver agreement and prediction of polyp histology Gastrointest Endosc 2009 69 716 722 19251016
  18. [18]Rastogi A Bansal A Wani S Narrow-band imaging colonoscopy—a pilot feasibility study for the detection of polyps and correlation of surface patterns with polyp histologic diagnosis Gastrointest Endosc 2008 67 280 286 18155210
  19. [19]East JE Suzuki N Bassett P Narrow band imaging with magnification for the characterization of small and diminutive colonic polyps: pit pattern and vascular pattern intensity Endoscopy 2008 40 811 817 18828077
  20. [20]van den Broek FJ Reitsma JB Curvers WL Systematic review of narrow-band imaging for the detection and differentiation of neoplastic and nonneoplastic lesions in the colon (with videos) Gastrointest Endosc 2009 69 124 135 19111693
  21. [21]Henry ZH Yeaton P Shami VM Meshed capillary vessels found on narrow-band imaging without optical magnification effectively identifies colorectal neoplasia: a North American validation of the Japanese experience Gastrointest Endosc 2010 72 118 126 20381799
  22. [22]Sikka S Ringold DA Jonnalagadda S Comparison of white light and narrow band high definition images in predicting colon polyp histology, using standard colonoscopes without optical magnification Endoscopy 2008 40 818 822 18668472
  23. [23]Tischendorf JJ Schirin-Sokhan R Streetz K Value of magnifying endoscopy in classifying colorectal polyps based on vascular pattern Endoscopy 2010 42 22 27 19899031
  24. [24]Ignjatovic A East JE Guenther T What is the most reliable imaging modality for small colonic polyp characterization? Study of white-light, autofluorescence, and narrow-band imaging Endoscopy 2011 43 94 99 21271465
  25. [25]Buchner AM Shahid MW Heckman MG Comparison of probe-based confocal laser endomicroscopy with virtual chromoendoscopy for classification of colon polyps Gastroenterology 2010 138 834 842 19909747
  26. [26]Lee CK Lee SH Hwangbo Y Narrow-band imaging versus I-Scan for the real-time histological prediction of diminutive colonic polyps: a prospective comparative study by using the simple unified endoscopic classification Gastrointest Endosc 2011 74 603 609 21762907
  27. [27]van den Broek FJ Fockens P Van Eeden S Clinical evaluation of endoscopic trimodal imaging for the detection and differentiation of colonic polyps Clin Gastroenterol Hepatol 2009 7 288 295 19168154
  28. [28]Kuiper T van den Broek FJ Naber AH Endoscopic trimodal imaging detects colonic neoplasia as well as standard video endoscopy Gastroenterology 2011 140 1887 1894 21419769
  29. [29]Hassan C Pickhardt PJ Rex DK A resect and discard strategy would improve cost-effectiveness of colorectal cancer screening Clin Gastroenterol Hepatol 2010 8 865 869 869 e1 3 20621680

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Authors
Ladabaum, U., Fioritto, A., Mitani, A., Desai, M., Kim, J. P., Rex, D. K., Imperiale, T., & Gunaratnam, N.
Affiliations
  • Stanford Medicine (US)
  • Indiana University Indianapolis (US)
Corresponding author
Ladabaum, Uri
ORCID
Venue
Gastroenterology
Publisher
Elsevier BV
Published
2013-01
Volume
144
Issue
1
Pages
81-91
ISSN
0016-5085 (ISSN-L)
DOI
10.1053/j.gastro.2012.09.054
PMC
PMC5518757
OpenAlex
W2075246611
Cited by
224
References
0
Citations by year
2026: 4 · 2025: 4 · 2024: 8 · 2023: 10 · 2022: 15 · 2021: 16 · 2020: 19 · 2019: 26 · 2018: 20 · 2017: 14 · 2016: 17 · 2015: 26 · 2014: 24 · 2013: 20
FWCI
10.49
Type
journal article
Language
en
Open access
Licence
Locations
  • Gastroenterology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
School of Medicine, Stanford University
Topics
  • Health Sciences › Medicine › Oncology › Colorectal Cancer Screening and Detection
  • Physical Sciences › Computer Science › Artificial Intelligence › AI in cancer detection
  • Health Sciences › Medicine › Oncology › Colorectal Cancer Surgical Treatments
Keywords
optical biopsy, narrow-band imaging, colorectal polyps, adenoma detection, diminutive polyps, gastroenterologist training, learning curve, surveillance interval, negative predictive value
MeSH terms
Adenoma, Biopsy, Colonic Neoplasms, Colonic Polyps, Colonoscopy, Community Health Services, Gastroenterology, Humans, Image Enhancement, Predictive Value of Tests, Confidence Intervals, Odds Ratio, Learning Curve, Optical Imaging

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